1699040956 NPI number — CONNECTICUT GENERAL LIFE INSURANCE COMPANY (CGLIC)

Table of content: MISS DE'ONNA SHARICE BRAZELL LPN (NPI 1376752527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699040956 NPI number — CONNECTICUT GENERAL LIFE INSURANCE COMPANY (CGLIC)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTICUT GENERAL LIFE INSURANCE COMPANY (CGLIC)
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CIGNA ONSITE HEALTH, LLC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699040956
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25500 N NORTERRA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85085-8200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-733-1710
Provider Business Mailing Address Fax Number:
623-277-1091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 23RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51501-6958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-319-9405
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SLICE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
623-277-2351

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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